The National Institutes of Health Should Extend the Systems-Level Approach to Include Extramural Research.

Abstract

To the Editor: We appreciate Dr. Valantine’s commentary describing efforts within the National Institutes of Health (NIH) to promote change that leads to gender parity. 1 We especially applaud both the recognition that individuals alone have a limited impact and also the systems-level approach taken to foster cultural change promoting inclusion within the intramural research program. This work within the NIH intramural program is an important step, and we call on the NIH to apply a similar systems-level approach to its extramural program, particularly given that $8 out of every $10 appropriated to the NIH is directed to the extramural program. 2 Gender inequity is well described among biomedical researchers. The NIH Data Book3 clearly shows these disparities. Only one-third of NIH research grants are awarded to women. Further, the funding amount of research grants is on average 10% lower for women than for men. Recent years show promising signs, including a steady (albeit slow) increase in the percentage of women serving as principal investigators for research grants over the past 20 years, and the fact that over half of mentored research career awards were awarded to women in 2018. This progress is encouraging, yet directed efforts at the systems level are necessary. To ensure this positive momentum continues, we recommend that the NIH systematically examine the gender and race/ethnicity of its reviewers, scientific review officers, and program officers who impact funding decisions. Beyond describing the individual’s characteristics, it is necessary to evaluate the relationship between reviewer gender and race/ethnicity, principal investigator gender and race/ethnicity, and outcomes of funding proposals. Understanding these data is a critical first step to taking systems-level action to decrease disparities. These evaluations must also be carried out on an ongoing basis and their results shared in the NIH Data Book to ensure transparency. The NIH has the opportunity to lead a systems-level approach to enact cultural change within its extramural program. These efforts would be an important step to positively impact the persistent gender inequities among biomedical researchers and fix the leaky pipeline that is historically present within academic medicine.